Progress in prevention of mother-to-child transmission of HIV infection in Ukraine: results from a birth cohort study

Abstract

BackgroundUkraine was the epicentre of the HIV epidemic in Eastern Europe, which has the most rapidly accelerating HIV epidemic world-wide today; national HIV prevalence is currently estimated at 1.6%. Our objective was to evaluate the uptake and effectiveness of interventions for prevention of mother-to-child transmission (PMTCT) over an eight year period within operational settings in Ukraine, within the context of an ongoing birth cohort study.MethodsThe European Collaborative Study (ECS) is an ongoing birth cohort study in which HIV-infected pregnant women identified before or during pregnancy or at delivery were enrolled and their infants prospectively followed. Three centres in Ukraine started enrolling in 2000, with a further three joining in September 2006.ResultsOf the 3356 women enrolled, 21% (689) reported current or past injecting drug use (IDU). Most women were diagnosed antenatally and of those, the proportion diagnosed in the first/second trimester increased from 47% in 2000/01 (83/178) to 73% (776/1060) in 2006/07 (p < 0.001); intrapartum diagnosis was associated with IDU (Adjusted odds ratio 4.38; 95%CI 3.19–6.02). The percentage of women not receiving any antiretroviral prophylaxis declined from 18% (36/205) in 2001 to 7% in 2007 (61/843) (p < 0.001). Use of sdNVP alone substantially declined after 2003, with a concomitant increase in zidovudine prophylaxis. Median antenatal zidovudine prophylaxis duration increased from 24 to 72 days between 2000 and 2007. Elective caesarean section (CS) rates were relatively stable over time and 34% overall. Mother-to-child transmission (MTCT) rates decreased from 15.2% in 2001 (95%CI 10.2–21.4) to 7.0% in 2006 (95%CI 2.6–14.6). In adjusted analysis, MTCT risk was reduced by 43% with elective CS versus vaginal delivery and by 75% with zidovudine versus no prophylaxis.ConclusionThere have been substantial improvements in use of PMTCT interventions in Ukraine, including earlier diagnosis of HIV-infected pregnant women and increasing coverage with antiretroviral prophylaxis and the initial MTCT rate has more than halved. Future research should focus on hard-to-reach populations such as IDU and on missed opportunities for further reducing the MTCT rate.

Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine

“…13 Data collection takes place at delivery and then as often as infant follow-up allows. The study began enrolment in Ukraine in 2000 and seven Ukrainian centres for HIV care currently participate.…”

“…Informed consent is obtained for collection of linked anonymous data on maternal, infant and delivery characteristics and clinical parameters. 13 The study protocol was approved by the Great Ormond Street Hospital for Children NHS Trust/Institute of Child Health Research Ethics Committee and by local institutional review boards. For the present data analyses, 54 infants who were products of multiple pregnancies but were not the firstborn infant of the multiple birth were excluded from the study (Fig.…”

“…10 Following the scale-up of PMTCT services in Ukraine, the rate of MTCT fell from 15% in 2001 to 6-7% in 2007, although the annual numbers of new infections in women of childbearing age -many of which had been acquired heterosexually -increased over the same period. 1,3,[11][12][13] By 2011, the prevalence of HIV infection among pregnant women was higher in Ukraine (0.47%) than in any other country in Europe 1 and exceeded 3% in some regions of the country (personal communication, Natalya Nizova, 2012). In 2007, 92% of the HIV-positive pregnant women in Ukraine received ART, and PMTCT prophylaxis was based on AZTm and sdNVP.…”

“…In 2007, 92% of the HIV-positive pregnant women in Ukraine received ART, and PMTCT prophylaxis was based on AZTm and sdNVP. 13,14 In November 2007, the country's Ministry of Health recommended the national implementation of WHO's Option-B strategy. The present study was based on data collected in Ukraine between 2008 and 2010 as part of a larger, prospective, observational study of HIV-positive pregnant women and their infants.…”

Does the national program of prevention of mother to child transmission of HIV (PMTCT) reach its target in Ouagadougou, Burkina Faso?

“…Of these infections, 90% occur in Sub Saharan Africa (SSA). Currently, effective strategies to reduce MTCT risk in resources limited settings are available [3][4][5][6][7][8][9][10][11][12][13][14][15][16] . They are widespread and the global commitment towards the Prevention of MTCT (PMTCT) of HIV is significant.…”